Pathology of Pemphigoid Gestationis (Herpes Gestationis)

Dr Sampurna Roy MD 2022

The name Herpes gestationis ( gestational pemphigoid ) was coined by Milton in 1872.

Pemphigoid Gestationis is a rare autoimmune blistering skin disorder that almost exclusively presents during pregnancy (usually in the second and third trimester of pregnancy).

It has been estimated to occur in 1:50,000 pregnancies [Shornick et al. In: J Am Acad Dermatol 8:214-224, 1983].

It is characterized by pruritic, urticarial plaques with the development of tense vesicles and bullae within the lesions.

Pemphigoid gestationis has been associated with premature delivery, small-for-gestational-age infants.

In some cases it is associated with hydatidiform mole and choriocarcinoma.

Clinically, the lesion is initially located in the periumbilical region as plaques and papules and then the lesion gradually becomes vesiculobullous in nature and spreads to involve the trunk and extremities.

Microscopic features:

- The subepidermal vesiculobullous lesions contain lymphocytes, eosinophils and histiocytes.

- There is prominent edema of the papillary dermis.

- Mild inflammatory infiltrate is noted in the superficial and mid dermis.

- The inflammatory infiltrate may form small microabcess in the dermal papilla.

Direct immunofluorescence (DIF) shows linear C3 deposition and sometimes IgG.